Abstract: FR-PO0215
Efficacy of Ascorbic Acid as Adjunct Therapy for Erythropoietin-Hyporesponsive Anemia in Patients on Hemodialysis: Systematic Review and Meta-Analysis
Session Information
- Anemia and Iron Metabolism
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Anemia and Iron Metabolism
- 200 Anemia and Iron Metabolism
Authors
- Calderon Martinez, Ernesto, The University of Texas Health Science Center at Houston, Houston, Texas, United States
- Sánchez Cruz, Camila, Universidad Nacional Autonoma de Mexico, Mexico City, CDMX, Mexico
- De la Rosa Valdez, España, Universidad Autonoma de Nuevo Leon, San Nicolás de los Garza, N.L., Mexico
- Villa, Montserrat, Centro de Estudios Universitarios Xochicalco, Xochicalco, Mor., Mexico
- Magallanes Bajana, Angelo, Universidad de Guayaquil, Guayaquil, Guayas, Ecuador
- Beltran Covarrubias, Salma Alejandra, Universidad de Guadalajara, Guadalajara, Jal., Mexico
- Cruz Castillo, Yeison, Universidad Autonoma de Santo Domingo, Santo Domingo, Dominican Republic
- Sámano, Michelle, Universidad Autonoma de Sinaloa, Culiacán, Sin., Mexico
- Chen, Alejandro, Centro de Estudios Universitarios Xochicalco, Xochicalco, Mor., Mexico
- Abbagoni, Vaidarshi, St. Vincent Medical Center, Bridgeport, Connecticut, United States
Background
Anemia is a prevalent morbidity in chronic kidney disease, particularly among hemodialysis-dependent patients. Despite standard erythropoiesis-stimulating agent (ESA) therapy, 5–10% exhibit hyporesponsiveness, frequently linked to inflammation and dysregulated iron homeostasis. Ascorbic acid has been proposed as an adjunct to augment ESA efficacy via enhanced iron mobilization. This systematic review and meta-analysis assessed its therapeutic impact in this context.
Methods
Following PRISMA guidelines, a systematic search of six databases was conducted through May 2025. Eligible studies were randomized or crossover trials assessing ascorbic acid in adult hemodialysis patients with ESA-treated anemia. Primary outcomes included hemoglobin (Hb), erythropoietin dose, ferritin, iron, transferrin saturation (TSAT), and total iron-binding capacity (TIBC). Meta-analyses used random-effects models. The protocol was preregistered in PROSPERO (CRD420251054491).
Results
From 479 screened articles, 11 studies met inclusion criteria. Meta-analysis showed ascorbic acid increased Hb (MD = 0.49 g/dL; 95% CI: 0.14–0.84; p < 0.01) and TSAT (MD = 9.72; 95% CI: 5.01–14.44; p < 0.01). TIBC decreased (MD = -34.02 ; 95% CI: -53.71 to -14.32; p < 0.01). No significant effects were observed for erythropoietin dose (SMD = -0.05; 95% CI: -0.72 to 0.61; p = 0.87), serum ferritin (MD = -46.12; 95% CI: -117.58 to 25.35; p = 0.21), or serum iron (MD = -4.58; 95% CI: -44.22 to 35.06; p = 0.82).
Conclusion
Ascorbic acid shows potential as an adjunct to optimize iron metabolism and improve hematologic response in ESA-treated hemodialysis patients. However, high heterogeneity calls for rigorous trials to define its clinical utility.
Meta-analysis findings
| Outcomes | Effect Estimate (95% CI, p-value) | Interpretation |
| Hemoglobin | MD = 0.49 (0.14 to 0.84), p < 0.01 | Significant increase |
| Transferritin saturation | MD = 9.72 (5.01 to 14.44), p < 0.01 | Significant increase |
| Total Iron-Binding Capacity | MD = -34.02 (-53.71 to -14.32), p < 0.01 | Significant increase |
| Erythropoietin dose | SMD = -0.05 (-0.72 to 0.61), p = 0.87 | No significant effect |
| Ferritin | MD = -46.12 (-117.58 to 25.35), p = 0.21 | No significant effect |
| Iron | MD = -4.58 (-44.22 to 35.06), p = 0.82 | No significant effect |
MD = Mean Difference;SMD = Standardized Mean Difference;CI = Confidence Interval.